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Page 1: Thesis or Dissertation Defense - A-State · Thesis or Dissertation Defense (To be completed and filed after the defense) Date: Department: Student ID Number: Student Name: College:

Thesis or Dissertation Defense (To be completed and filed after the defense)

Date:

Department:

Student ID Number:

Student Name:

College:

Degree:

Advisor:

Thesis/Dissertation Title:

ID Number:

If thesis/dissertation completed successfully, sign below.

Program Director Signature:

College Dean Signature:

Form must be submitted to the Office of Admissions, Records and Registration after electronic signatures are completed. Please ensure any relevant additional documentation is attached to the generated email.

Signatures of Committee Members:

Chair:

Member:

Member:

Member:

Member:

Member:

Member:

Member:

The above-named candidate has been examined by the committee with the following results:

The above-named candidate has successfully completed the final version of the thesis or dissertation:

Passed:

Passed:

Failed:

Failed:

12/16

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